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Monday, 20 June 2016

What can we learn from primary care in Finland?

Josep Vidal Alaball

Finland is a leader in many aspects of the welfare system. It’s well known that they have one of the best educational systems in the world; but what can we learn from their primary care system that can be useful for our area? With this article I want to convey some personal reflections about some peculiarities of the Finnish health system and a comparison with our own model.

Finland is a northern European country with 5.5 million inhabitants and a member of the European Union since 1995. Its health system provides universal coverage and it is noteworthy that health and social services are managed from the same government department.

Focusing on primary care in Finland, the fact that they count with an electronic medical record system deployed throughout the primary care network with access to all electronic medical records of all hospitals, as well as analytical and radiological tests is noteworthy. Some regions, such as Catalonia, have evolved a lot in recent years, but we still need to move towards a single clinical centre and a more agile and direct access to the medical records of all hospitals in the public health care network, including clinical courses. We must also consider, being an issue of patient safety, how we could access the medical records of hospitals and private clinics.

In Finland, each local government is responsible for funding health centres in their area. This has caused some inequalities between different geographical areas, accentuated by the fact that 30% of primary care is performed in a rural setting, but on the other hand, it certainly has the effect of a better understanding the health needs locally. In Catalonia we count with some decentralization experiences that are somehow comparable in this regard, such as the financing models population-based, but this is a model that has never been implemented evenly throughout the territory and that for years has been in the "pilot" phase.

An interesting initiative of the Finnish primary care system is the "Health Stations" located mainly in the Helsinki capital. There are now 25 such centres that receive entirely public funding. The remarkable features of these primary care stations are the fact that that they work in professional medical and nursing teams, formed in pairs similar to our model, and the fact that these centres have areas of self-care where patients may, for example, take their own blood pressure or monitor other aspects of their health and welfare. In addition, these centres include specialized mental health services, dental, substance abuse, paediatrics and sexual and reproductive health. They also have telephone hotlines for users, managed by nurses.

But the Finnish primary care also has some problems and in this sense is not much different from our own health system: long waiting lists for visits for the outpatient, difficulty in capturing the best medical students to be trained as family doctors, too much reliance on specialized hospital care and a lack of historical funding in hospital care.

In short, our primary care will is not too far off when compared to Finland, but what makes me envious of them is that in Finland, primary care has a long academic history as there are departments of Family Medicine in each of the five public medical schools in the country. This is a subject that is pending in our country and postponing it is unfair and unjustifiable.